Background Papillary thyroid carcinoma (PTC) has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of re-operations performed for persistent, rather than truly recurrent disease. Methods We conducted a retrospective review of a prospectively maintained database. Patients with PTC that had re-operation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and negative ultrasound within one year of surgery. Results A total of 69 patients underwent 92 re-operations. On initial pathology: mean tumor size was 2.6cm; 50.7% were multifocal; and 42% had extra-thyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at initial surgery and 76.8% were treated with post-operative radioactive iodine. The median time to first re-operation was 21 months (range, 1–292), and 41.8% occurred within 1 year. Only three operations met criteria for true “recurrence”, while 71 operations were categorized as persistence. Conclusion Many re-operations for PTC are for management of persistent disease. Over half of the patients required re-operation within the first two years, which strongly suggests that improvements in the pre-operative assessment and adequacy of initial surgery need to be made to improve the care of patients with thyroid cancer.

WHAT'S KNOWN ON THIS SUBJECT: Currently, the false-positive rate of appendicitis in children is #5%. Abdominal imaging and blood tests (particularly leukocytosis) help minimize the negative appendectomy rate, but appendicitis is not always associated with an elevated white blood cell count. WHAT THIS STUDY ADDS:Reducing the threshold of leukocytosis as a criterion for appendicitis to 8000 to 9000 white blood cells per mL improves specificity (negative appendectomy: ,1%) while only marginally decreasing sensitivity. abstract BACKGROUND: Despite increased utilization of laboratory, radiologic imaging, and scoring systems, negative appendectomy (NA) rates in children remain above 3% nationwide. We reviewed the clinical data of patients undergoing appendectomy to further reduce our NA rate. METHODS:A retrospective review was conducted of all appendectomies performed for suspected appendicitis at a tertiary children' s hospital during a 42-month period. Preoperative clinical, laboratory, and radiographic data were collected. Variables absent or normal in more than half of NAs were further analyzed. Receiver operating characteristic curves were constructed for continuous variables by using appropriate cutoff points to determine sensitivity and falsepositive rates. The results were validated by analyzing the 12 months immediately after the establishment of these rules. RESULTS:Of 847 appendectomies performed, 22 (2.6%) had a pathologically normal appendix. The only variables found to be normal in more than half of NAs were white blood cell (WBC) count (89%) and neutrophil count (79%). A receiver operating characteristic curve indicates that using WBC cutoffs of 9000 and 8000 per mL yielded sensitivities of 92% and 95%, respectively, and reduction in NA rates by 77% and 36%, respectively. Results observed in the subsequent 12 months confirmed these expected sensitivities and specificities.CONCLUSIONS: Absence of an elevated WBC count is a risk factor for NA. Withholding appendectomy for WBC counts ,9000 and 8000 per mL reduces the NA rate to 0.6% and 1.2%, respectively. Missed true appendicitis in patients with normal WBC counts can be mitigated by a trial of observation in those presenting with early symptom onset.

According to population-based SEER registry data, the extent of initial resection may not significantly change DSS in patients with MTC confined to the central neck.

Background Potassium iodide (KI) is often prescribed prior to thyroidectomy for Graves’ disease, but the effect of KI on the ease and safety of thyroidectomy for Graves’ is largely unknown. Methods We conducted a prospective cohort study of patients with Graves’ disease undergoing thyroidectomy. For the first 8-months no patients received KI; for the next 8-months, KI was added to the pre-operative protocol for all patients. Outcomes included operative difficulty (based on the Thyroidectomy Difficulty Scale) and complications. Results A total of 31 patients in the no-KI group and 28 in the KI group were included. According to the Thyroidectomy Difficulty Scale, gland vascularity decreased in the KI group (mean score 2.6 vs. 3.3, p=0.04), but there were no significant differences in thyroid friability, fibrosis, size, or overall difficulty (p=NS for all). Despite similar operative difficulty, patients prescribed KI were less likely to experience transient hypoparathyroidism (7.1% vs. 25.9%, p=0.018) and transient hoarseness (0% vs. 16.1%, p=0.009) compared with the no-KI group. Conclusion KI administration decreases gland vascularity but does not change the overall difficulty of thyroidectomy. However, KI was associated with less transient hypoparathyroidism and transient hoarseness, suggesting that KI improves the safety of thyroidectomy for Graves’ disease.